Watts in the Telegraph-Journal: Canada falling behind in health-care efficiency

In the third entry, he shows how Canada is falling behind other countries when it comes to health care performance.

Michael Watts, Oct. 14, 2013, The Telegraph-Journal

Available data paint a stark picture of the financial costs and the quality of outcomes currently attached to Canada's health care system.

Quite simply, Canada cannot afford to continue spending at this pace. The Office of the Parliamentary Budget Officer has projected that the provinces' and territories' debts, in relation to GDP, will "increase substantially over the long term from 20 per cent in 2010/11 to over 125 per cent in 2050/51 and to over 480 per cent by 2085/86." As a result, the Parliamentary Budget Officer estimates that the "provincial-territorial fiscal gap is now +2.9 per cent of GDP, indicating that . . . provincial-territorial governments would need to raise revenue, reduce program spending, or some combination of both (by $49 billion in 2011/12 and increasing over time in line with nominal GDP) to achieve fiscal sustainability."

Authors at the Fraser Institute analysed 2011 OECD data and calculated that the following was true of Canada in 2009:

* It ranked below 27 other OECD countries "in almost every indicator of medical resource availability and the output of medical services for which comparable data were available."

* It ranked below the OECD average for 15 of 20 health care quality indicators.

* It ranked 19 (out of 23 countries) for the number of practising physicians per population.

* It tied for last place (out of 26 countries) for the number of acute care beds per population.

In short, this "analysis suggests that relative to the majority of OECD countries, Canada's health insurance system does not produce good value for money."

Hospitals' and provinces' responses to the financial difficulties noted above also have led to (perhaps unintended) degradation in the quality of health services. One example is that hospitals have joined third-party shared services organizations (some covering large metropolises, others covering major portions of the country, and some covering all of Canada) in order to use their combined purchasing power to reduce the costs of, for example, durable medical equipment and pharmaceuticals.

Unfortunately, not only does this enable hospitals to contain costs, it also results in business decisions being made for a large number of hospitals which are not related to the clinical decisions that physicians in those hospitals would make. In practice, this means that a shared service organization may have a short list (or possibly even one) product (such as a hip prosthesis) that it purchases for all of the member hospitals, and physicians will have to choose from that short list (or use the only product purchased) when treating their patients, whether or not that is the best clinical choice or even a good clinical choice for the individual patient.

The Canadian Medical Association (CMA) has been outspoken in its criticism, concluding that the "system is failing Canadians, especially vulnerable populations." At a CMA gathering in St. John's in August of 2011, the Association stated that: "it's not money that's the problem. Yes, Canada faces the pressure of rising demand and limited resources - but so do other developed countries, many of whom are navigating the challenge more successfully while spending less than Canada."

Since the Canada Health Act is not tailored to dealing with an aging population or chronic illness, Canada's health care system is becoming more difficult to sustain and the gap is widening between what is truly medically necessary (from a clinical point of view) and what is publicly insured.

Immediate transformation only can occur if provinces cease viewing the Act, and Ottawa's enforcement role, as an obstacle to reform. If provinces opt to maintain the status quo because provincial legislators are responding to a political perception that changing the current system is contrary to their political interests, then the problems relating to the sustainability and access to our current publically funded health care system will have to reach a critical point before action is taken.

The evidence accepted by the Supreme Court majority in the Chaoulli case established that the availability of private health care is more likely to enhance the public health care system than weaken it:

"After reviewing a number of public health care systems, the Standing Senate Committee on Social Affairs, Science and Technology concluded in the Kirby Report that far from undermining public health care, private contributions and insurance improve the breadth and quality of health care for all citizens, and it ultimately concluded, at p. 66: The evidence suggests that a contribution of direct payments by patients, allowing private insurance to cover some services, even in publicly funded hospitals, and an expanded role for the private sector in the delivery of health services are the factors which have enabled countries to achieve broader coverage of health services for all their citizens.

Some countries like Australia and Singapore openly encourage private sector participation as a means to ensure affordable and sustainable health services.

"Nor does it appear that private participation leads to the eventual demise of public health care. It is compelling to note that not one of the countries referred to re[239 191 189 ]lies exclusively on either private insurance or the public system to provide health care coverage to its citizens...

"In summary, the evidence on the experience of other western democracies refutes the government's theoretical contention that a prohibition on private insurance is linked to maintaining quality public health care."

Michael Watts is a partner at Osler, Hoskin & Harcourt LLP and Chair of the firm's National Health Industry Group. This series was written for theMacdonald-Laurier Institute and syndicated by www.troymedia.com

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